ATI RN
RN ATI Pediatric Nursing Proctored Exam with NGN 2023 Questions
Extract:
Nurses’ Notes
1000:
Child has been brought to the clinic by their parent due to a report of right arm pain. The parent states that several hours ago the child tripped and fell onto the sidewalk while playing outside. The child states, "I was running when we were playing, and tripped over a curb.” Child is supporting their arm across their body.
Assessment
Child is alert and appears developmentally appropriate for their age and well nourished.
Respirations easy and unlabored. Abdomen non-distended. Right forearm and fingers are edematous. Ecchymotic area noted on outer aspect of the forearm. Radial pulse =2. Fingers slightly cool to touch. Child can move fingers and reports a mild “tingling” sensation. Child verbalizes a pain level of 4 on a scale of 0 to 10. Multiple areas of bruising are noted on lower extremities in various stages of healing
Vital Signs
1000
Temperature 368° C (98.2°F)
Heart rate 102/min
Respirator ate 22min '
BP 100/60 mm Hg
Oxygen saturation 98% on room air
Provider Prescriptions
1030;
Obtain x-rays of right arm, wrist, and elbow.
1145:
Ibuprofen 200 mg PO PRN pain rating of 5 on a scale of 00 10
Consult orthopedic department for cast application
1400:
Discharge to home.
Follow-up in office in 2 weeks.
Review synthetic cast care instructions with child and family.
Question 1 of 5
A nurse is caring for a 9-year-old at a clinic. The nurse reviews the assessment findings. Select findings that require immediate follow up. Select all that apply.
Correct Answer: A,C,E,F
Rationale: The correct answers are A, C, E, and F.
A: Edematous right forearm and fingers can indicate a potential circulatory issue requiring immediate follow-up.
C: Fingers slightly cool to touch suggest poor circulation, requiring further assessment.
E: Heart rate of 102/min in a 9-year-old is above normal, indicating possible distress.
F: Respiratory rate of 22/min is slightly elevated and could indicate respiratory distress.
B, D, G are not immediate concerns as a non-distended abdomen, oxygen saturation of 98% on room air, and an ecchymotic area on the forearm do not require immediate follow-up in this context.
Extract:
Question 2 of 5
A nurse in an emergency department is caring for a 3-year-old child who has suspected epiglottitis. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Prepare to assist with intubation. Epiglottitis is a medical emergency that can cause rapid airway obstruction. Intubation ensures a secure airway and oxygenation. Throat culture (
B) is not a priority in this acute situation. Suctioning (
C) can provoke spasm and worsen obstruction. Cool mist tent (
D) does not address the immediate need for securing the airway.
Extract:
Nurses’ Notes
1000:
Child has been brought to the clinic by their parent due to a report of right arm pain. The parent states that several hours ago the child tripped and fell onto the sidewalk while playing outside. The child states, "I was running when we were playing, and tripped over a curb.” Child is supporting their arm across their body.
Assessment
Child is alert and appears developmentally appropriate for their age and well nourished.
Respirations easy and unlabored. Abdomen non-distended. Right forearm and fingers are edematous. Ecchymotic area noted on outer aspect of the forearm. Radial pulse =2. Fingers slightly cool to touch. Child can move fingers and reports a mild “tingling” sensation. Child verbalizes a pain level of 4 on a scale of 0 to 10. Multiple areas of bruising are noted on lower extremities in various stages of healing
Vital Signs
1000
Temperature 368° C (98.2°F)
Heart rate 102/min
Respirator ate 22min '
BP 100/60 mm Hg
Oxygen saturation 98% on room air
Provider Prescriptions
1030;
Obtain x-rays of right arm, wrist, and elbow.
1145:
Ibuprofen 200 mg PO PRN pain rating of 5 on a scale of 00 10
Consult orthopedic department for cast application
1400:
Discharge to home.
Follow-up in office in 2 weeks.
Review synthetic cast care instructions with child and family.
Question 3 of 5
The nurse is continuing to care for the child. Complete the following sentence by using the list of options. The child is at highest risk of developing------ as evidenced bt the child's------
Correct Answer: C,F
Rationale: The correct answer is C, Compartment syndrome, and F, Paresthesia. Compartment syndrome results from increased pressure within a closed anatomical space, leading to compromised blood flow and nerve function. Paresthesia, abnormal sensations like tingling or numbness, is an early sign of nerve compression in compartment syndrome. The combination of these symptoms indicates a critical condition requiring immediate intervention to prevent tissue damage.
Choices A, B, D, and E do not align with the clinical presentation of compartment syndrome, whereas choice G, weak pulses, may be seen in severe cases but are not specific enough to be the highest risk factor in this scenario.
Extract:
Question 4 of 5
A nurse is caring for a child who has cystic fibrosis and requires postural drainage. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A. Performing postural drainage prior to meals helps prevent aspiration of food or stomach contents during the procedure. Postural drainage is typically done 1-2 hours after meals to minimize the risk of aspiration. Holding the hand flat (
B) is incorrect as cupped hands are used for percussion to avoid injury. Administering a bronchodilator after (
C) can lead to increased mucous production. Performing the procedure twice daily (
D) is generally recommended, but the timing in relation to meals is crucial.
Question 5 of 5
A nurse is caring for a school-age child who has sickle cell anemia and is in vaso-occlusive crisis. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Increase oral fluid intake. During a vaso-occlusive crisis in sickle cell anemia, there is a blockage of blood flow leading to tissue ischemia and pain. Increasing oral fluid intake helps to hydrate the child and improve blood flow, potentially reducing the severity of the crisis. Cold compresses (
A) can worsen vasoconstriction, platelet transfusion (
B) is not indicated for vaso-occlusive crisis, and active range of motion exercises (
C) can exacerbate pain and further compromise blood flow. Increasing fluid intake is the most appropriate intervention to help manage the crisis.